Healthy Lifestyle Behaviors Attenuate the Effect of Poor Sleep Patterns on Chronic Kidney Disease Risk: A Prospective Study from the UK Biobank.

Objectives: This study aimed to assess the impact of modifiable lifestyle behaviors on the association between sleep patterns and chronic kidney disease (CKD) risk.

Methods: This study included 294,215 UK Biobank participants initially without CKD, followed until 13 October 2023. Sleep patterns were derived from five sleep factors, including sleep duration, chronotype, insomnia, snoring, and daytime dozing. The healthy lifestyle score (HLS) was newly calculated based on smoking status, physical activity, diet, body mass index, and mental health. Cox's proportional hazards models were used to assess the associations between sleep patterns, HLS, and CKD risk.

Results: A total of 17,357 incident CKD cases were identified during a median follow-up of 14.5 (interquartile range: 13.7-15.3) years. Both sleep patterns and HLS were independently associated with increased CKD risk (-trend < 0.001). Importantly, the HLS was found to modify the association between sleep patterns and CKD risk (-interaction = 0.026). Among participants with a low HLS, medium (HR = 1.12; 95% CI 1.05-1.19) and poor sleep patterns (HR = 1.23; 95% CI 1.17-1.30) increased CKD risk to varying degrees, whereas no significant association was observed for a high HLS. Moreover, the combination of a low HLS and poor sleep pattern significantly increased the risk of incident CKD (HR = 2.19; 95% CI 2.00-2.40).

Conclusions: A high HLS may significantly reduce CKD risk associated with poor sleep, whereas a low HLS may exacerbate this risk. These findings underscore the critical importance of lifestyle interventions as a primary prevention strategy for CKD.